Provider Demographics
NPI:1962445361
Name:BOYD, CARL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:RICHARD
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-8712
Mailing Address - Fax:912-350-8753
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-8712
Practice Address - Fax:912-350-8753
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0186092086S0102X, 208600000X
SC221492086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000219865FMedicaid
GA000219865JMedicaid
GA349722OtherWELLCARE
SC384081Medicaid
GA000219865EMedicaid
GA020047971OtherRAILROAD MEDICARE
GA000219865IMedicaid
GA10063470OtherAMERIGROUP
SC384081Medicaid
GA000219865EMedicaid
GA000219865IMedicaid